Evaluation of Quality Improvement Performance in the Community Diabetes Education (CoDE) Program for Uninsured Mexican Americans

Abstract

The objective of this article is to quantify quality improvement using data from a randomized controlled trial that tested the effectiveness of a community health worker in the primary role of diabetes educator in a clinic serving uninsured Mexican Americans. The intervention group received 7 hours of diabetes education/case management in excess of usual medical care. Of 16 process and outcome measures evaluated, the intervention group was significantly more likely to have received a dilated retinal examination, and 53% achieved a hemoglobin A1c below 7% compared with 38% of the control group participants. Composite quality measures were similar in magnitude with published practice-based benchmarks at study conclusion. This suggests that the overall diabetes care delivered in this clinic serving uninsured patients was comparable to the levels of excellence achieved in other primary care settings. Quantitative measurements of quality improvement can inform health policy regarding the relative effectiveness of diabetes interventions.

Peer support of complex health behaviors in prevention and disease management with special reference to diabetes: systematic reviews

“…It used the differences attributable to peer support in an initial study (Prezio, 2013, 2014) [63, 100] and the Archimedes Model to estimate incidence of diabetes complications over twenty years. This led to an estimated incremental cost in the PS condition of $355 per quality adjusted life year gained.…”

What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis

“…The included studies were conducted between 1988 and 2013. Thirty-five studies (53%) were parallel-group patient RCTs enrolling 237,025 patients 59,[61][62][63]71,72,75,80,82,[85][86][87][88][89]95,96,98,99,102,103,[107][108][109][111][112][113][114][115][116][117][118][119][120][121][122] and 31 (47%) were cluster RCTs in which the HCP or the health-care setting was the unit of randomisation. 58,60,64-70, 73,74,76-79,81,83,84,90-94,97,100,101,104-106,110,123 These included 6126 clusters (range 6-4125 clusters).…”

“…With the exception of gender (reported in 93.9% of studies) and ethnicity (reported in 56.1% of studies), the characteristics of participants were poorly described and the relative effectiveness of the interventions in subgroups in terms of PROGRESS elements was never reported. Seventeen studies (25.8%) 60,62,63,68,72,75,91,96,[107][108][109][110]112,113,116,120,121 were conducted in disadvantaged populations and no studies were carried out in low-or middle-income countries.…”

“…In 12 (75%) 96,108,109,111,113,114,117,[119][120][121][122][123] of the 16 studies in which the primary target of the intervention was to improve attendance for DRS, the outcome was a dilated fundus examination (DFE) conducted by an ophthalmologist or optometrist during the follow-up period post intervention (median follow-up 12 months). The DFE was confirmed by medical record audit, from a health claims database or by eye-care professional examination.…”

The Impact of State Certification of Community Health Workers on Team Climate Among Registered Nurses in the United States

“…The evidence of the effectiveness, both in cost and health outcomes, of interventions using CHWs continues to increase [13][14][15][16], but RNs and other licensed health care workers may be hesitant to delegate duties to unlicensed or non-certified health care workers because of their concerns about quality and safety [17].…”